1Quality of Life, Spirituality and Coping, Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
2Freiburg Institute for Advanced Studies (FRIAS), Universität Freiburg, 79104 Freiburg, Germany
Copyright © 2013 Nora-Beata Erichsen and Arndt Büssing. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
While the research on spiritual needs of patients with chronic and life-threatening diseases increases, there is limited knowledge about psychosocial and spiritual needs of elderly living in residential/nursing homes. We were interested in which needs were of relevance at all, and how these needs are related to life satisfaction and mood states. For that purpose we enrolled 100 elderly living in residential/nursing homes (mean age years, 82% women) and provided standardized questionnaires, that is, Spiritual Needs Questionnaire (SpNQ), Brief Multidimensional Life Satisfaction Scale (BMLSS), Quality of Life in Elders with Multimorbidity (FLQM) questionnaire, and a mood states scale (ASTS). Religious needs and Existential needs were of low relevance, while inner peace needs were of some and needs for giving/generativity of highest relevance. Regression analyses revealed that the specific needs were predicted best by religious trust and mood states, particularly tiredness. However, life satisfaction and quality of life were not among the significant predictors. Most had the intention to connect with those who will remember them, although they fear that there is limited interest in their concerns. It remains an open issue how these unmet needs can be adequately supported.
1. Introduction
In societies with an increasing number of elderly which are not able to care for themselves any longer and thus decide—or others may have decided for them—to live in protected housing estates (i.e., residential homes, assisted accommodation, or residential nursing homes), there is a need to care not only for their physical health but also for their psychosocial aspects. Very old individuals living alone are often depressed; the risk factors include living in distance from family and low satisfaction with living accommodation and finances . However, individuals may experience depression also in nursing homes; the risk factors involve physical affections and limitations, loneliness and lack of social support, and so forth . Golden et al. clearly showed that loneliness and social networks have an independent influence on mood and well-being of community-dwelling elderly. In their study enrolling 1,299 elderly, 35% described themselves as lonely and 34% had a nonintegrated social network; nevertheless, also 32% of participants with an integrated social network reported being lonely . There is an obviously complex network of influencing variables which all point to the fact that older individuals require psychosocial support which is not available to their satisfaction.
A study from the late 80th stated that “older persons have significant needs that cannot be met by psychotherapy, social work, or other disciplines,” particularly because these elderly “often feel useless and without dignity” on the one hand and have to struggle with “thoughts of dying” on the other hand . A small pilot enrolling ten patients from a care of the elderly assessment unit found that elderly patients stated needs “related to religion, meaning, love and belonging, morality, and death and dying” .
Such needs indicate a gap between specific expectations and the situation as it is, or, in other words, “if the individual resources to deal with the challenges (⋯) are insufficient to restore well-being, patients may express specific needs” . With respect to patients’ unmet needs, patients may expect that the fulfillment of their spiritual needs can have a positive influence on their quality of life and life satisfaction. Of course expectations can be higher as they can be fulfilled, and the respective needs remain idealistic intentions, yet this will not argue against the fact that individuals may express such needs because they regard them as important for their current situation .
Spiritual needs do not necessarily refer to religious issues only, and they are not exclusively existential, too. From a theoretical point of view it is appropriate to differentiate psychosocial, existential and religious needs, yet, it is not practicable to separate these interconnected needs in a clinical context. Moreover, a specific need may have a religious connotation for one individual, and may have a clear existential connotation for an a-religious person. Moreover, the interpretation whether or not a specific need is a “spiritual” one depends on the individual attitudes and convictions, the underlying world view and the specific cultural context.
Our recent framework of spiritual needs for research and clinical practice thus distinguishes between four interconnected core dimensions of spiritual needs , that is, Connection, Peace, Meaning/Purpose, and Transcendence, and correspond to the underlying categories social, emotional, existential, and religious. These dimensions can be related to Alderfer’s ERG model which includes the needs categories Existence (i.e., physiological and safety needs), Relatedness (i.e., belongingness and external esteem needs), and Growth (i.e., self-actualization and internal esteem needs) (see ). According to the ERG model, specific needs may have stronger relevance particularly when other needs cannot be fulfilled. For example, when needs for self-actualization and internal esteem cannot be fulfilled under a given situation, then relational needs (i.e. family, friends, and religious sources) would become more important.
However, most of the studies addressing spiritual needs refer to chronic patients’ needs , and these patients are in most cases of higher age. Yet, the spiritual needs of patients with chronic and fatal diseases might be different from the needs of elderly which experience a decrease of their physical and mental abilities and an increasing social isolation, but must not necessarily be ill. So far research has verified that patients with life-threatening and/or chronic diseases regard their spirituality as a beneficial resource to cope , and thus acknowledging and supporting their spirituality are a main issue of spiritual care. But what about elderly which must not necessarily suffer from chronic illness but from increasing physical, mental and social restrictions? Do they have specific unmet spiritual needs?
The aim of this study was thus to analyze which psychosocial and spiritual needs were reported by elderly living in residential/nursing homes, and how these needs are connected with life satisfaction and mood states. We included also related variables such as perceived daily life impairment and self care abilities on the one hand, and religious trust on the other hand.
2. Materials and Methods2.1. Individuals
All individuals of this anonym cross-sectional study were informed about the purpose of the study, were assured of confidentiality, and consented to participate. One-hundred elderly living in 12 different residential/nursing homes for elderly and assisted accommodation homes from Schleswig-Holstein (northern parts of Germany, predominantly with a Protestant denomination were enrolled. The respective institutions were chosen because of their willingness to participate and convenient accessibility.
Inclusion criteria were age at least 65 years and written consent to participate; exclusion criteria were acute and significant health affections, and acute psychiatric disease which would impair the validity of obtained answers. We also did not include elderly with significant dementia.
When possible, nursing staff was consulted to advise which individuals might be suited to participate. Due to the fact that most of the interviewed persons had problems with reading and writing, the interviewer red the respective items to them and assisted filling the respective answers. During this process, all comments which would help to interpret the data were recorded.
Most of the contacted individuals showed interest to participate. Although some of these volunteers were first skeptically reserved because they had to talk about private concerns, they responded nevertheless willingly during the interviews. We strictly followed the commitment of voluntariness, and thus none of the residents was coerced to participate. Only 20 persons were not willing to participate.
2.2. Measures2.2.1. Psychosocial and Spiritual Needs
To measure psychosocial and spiritual needs, we used the Spiritual Needs Questionnaire (SpNQ) . This instrument can be used as a diagnostic instrument with 29 items and also as a validated measure of spiritual needs relying on 19 items . The instrument differentiates 4 main factors, that is, (1)religious needs (Cronbach’s alpha = .92), that is, praying for and with others, and, by themselves, participate at a religious ceremony, reading of spiritual/religious books, and turn to a higher presence (i.e., God, angels);(2)existential needs (reflection/meaning) (alpha = .82), that is, reflect previous life, talk with someone about meaning in life/suffering, dissolve open aspects in life, talk about the possibility of a life after death, and so forth;(3)need for inner peace (alpha = .82), that is, wish to dwell at places of quietness and peace, plunge into the beauty of nature, finding inner peace, talking with other about fears and worries, and devotion by others;(4)need for giving/generativity (alpha = .74) which addresses the active and autonomous intention to solace someone, to pass own life experiences to others, and to be assured that life was meaningful and of value.
For this analysis, we used three additional items asking for the need to be “more involved by the family in their life concerns,” to be “invited (again) to private meetings with friends,” and to “receive more support from the family.”
All items were scored with respect to the self-ascribed importance on a 4-point scale from disagreement to agreement (0—not at all; 1—somewhat; 2—very; and 3—extremely).
2.2.2. Religious Trust
To analyze religious trust, which should be associated with religious needs but not necessarily with the other needs, we used the respective 5-item subscale of the SpREUK questionnaire (SpREUK is an acronym of the German translation of “Spiritual and Religious Attitudes in Dealing with Illness”) . The scale avoids exclusive terms such as God, Jesus, or church in order not to exclude any and thus is suited particularly to secular societies. The Trust scale (alpha = .91), or trust in higher guidance/source, is a measure of intrinsic religiosity and deals with trust in spiritual guidance in life, the feeling to be connected with a higher source, trust in a higher power which carries through whatever may happen, and conviction that death is not an end, and so forth.
The scale scores items on a 5-point scale from disagreement to agreement (0, does not apply at all; 1, does not truly apply; 2, do not know (neither yes nor no); 3, applies quite a bit; and 4, applies very much). For all analyses, we used the mean score which was referred to a 100% level (transformed scale score). Scores >50% indicate higher agreement (high Trust), while scores 50% indicate higher life satisfaction, while scores
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Through our ministry, my husband, Roy and I speak and sing at conferences, banquets, crusades, revivals, and we also take the time to present programs at long-term care facilities across our state.
We are often told how we bring joy and a spark of life to the residents. We are happy we have the opportunity to share the talents God gave us in this way.
I will never forget a particular day when we visited a nursing home to present one of our programs. Roy sang and I spoke to people sitting in wheelchairs and others who were seated beside walkers. As I stared into the crowd, I noticed some of the residents were sleeping. Others were smiling. Thankfully, most were listening. Some were even tapping their feet.
After the program all the residents returned to their room, except one lady. While we were gathering up our belongings, she came over to us to tell us how much she enjoyed the program. We hugged and then exchanged small talk. She talked about her son. Then she followed with words that literally broke my heart.
“If you see my son, will you tell him I miss him?”
“Sure, I will,” I answered. I hugged her. For a few brief seconds I felt the pain she seemed to be feeling.
Now I don’t know the situation. Her son could have been there just that morning. Time doesn’t always register with elderly people. I am certain the days and hours have a way of running together when you seldom leave a place.
But then, on the other hand, it could have been weeks or months since he had visited with his mother. Too many people drop their loved ones off at a nursing home, vow to return often, but get busy and rarely return.
When my father was in a nursing home, I went to see him several times a week. My mother spent most of her waking hours there in his room with him. It wasn’t easy, especially since it was 65 miles from my front door to his. But we were determined my father would know that we loved him, even after he forgot who we were.
I had to turn away from this sweet lady and wipe away a few tears. Then I turned back around.
“My son is coming back to get me. He is going to take me home,” she announced.
I smiled and gave her another hug, wishing it was true. She walked slowly away. But once again she turned around and faced me.
“Will you tell my son that I love him when you see him?” she asked. I looked into her eyes and saw tears, beyond the smile, which automatically crossed her face just speaking of her son.
I don’t expect to ever see her son. Actually, if I did, I wouldn’t even know him. Therefore, in an effort to grant a sweet elderly lady’s heartfelt request, I am writing this story to tell everyone who has loved ones in long-term care facilities that your mother, father, aunt, or uncle misses you very much.
They would like for you to come visit with them. Even though you may not be able to take them home with you, you can go to their meager home for a brief visit. Your presence would make their day.
And don’t forget — your family member loves you with all of his or her heart. And I am certain, just like this lady, they want you to know just how much.
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One might think I have no business writing a post like this.
One might be right.
Because although my parents are aging in the sense that every human on the face of the planet is getting older day by day, they’re still far from elderly.
But while I may lack personal experience, I’ve had numerous opportunities to observe the examples of my parents and others caring for their aging parents.
People I’ve been blessed to watch firsthand as they’ve loved their elderly parents lavishly and served them sacrificially.
As I think of them and look to the Scriptures, I find plenty of inspiration that will encourage you as you begin praying the Scriptures for your aging parents.
Prayers for Aging Parents & Their Children
If your parents don’t know the Lord as Savior, pray that they would be saved, reminding God that He isn’t willing that any should perish, but that all should come to repentance (2 Peter 3:9). Ask the Lord to make this your parents’ testimony: “My mouth is filled with Your praise, and with Your glory all the day.” Pray that the Lord wouldn’t forsake them in their old age, that they might proclaim His might to another generation (Psalm 71:8,9,18).
Ask the Lord to be the strength of your parents’ hearts and their portion forever, even though their flesh and heart may fail (Psalm 73:26).
Pray that by God’s grace, your parents would not be discouraged as they age, knowing that although their bodies are wasting away, their spirits are being renewed day by day (2 Corinthians 4:16).
Ponder the truth that the righteous flourish like the palm tree and grow like a cedar in Lebanon, still bearing fruit in old age. Ask God to enable your parents to declare, “The Lord is upright; He is my rock, and there is no unrighteousness in Him” (Psalm 92:12-15).
Ask the Lord to help your father to be sober-minded, dignified, self-controlled, sound in faith, in love, and in steadfastness. Pray that your mother would be reverent in behavior, and not a slanderer. Ask God to help her teach what is good, continuing to serve as an example of love for her husband and children, as well as self-control, purity, industriousness, kindness, and submission to her husband (Titus 2:2-5).
Pray that God would help you to honor your father and your mother all the days of your life (Exodus 20:12). Ask that He would guide you in treating your parents with respect, not rebuking them but encouraging them with a pure heart (I Timothy 5:1-2).
Commit to the Lord your desire to care for your parents in whatever way He desires. Ask Him to help you show godliness to them, returning to them a portion of all they’ve done for you, for this is pleasing in the sight of God (I Timothy 4:5).
Claim God’s promise that He is able to make all grace abound to you, so that having all sufficiency in all things at all times, you may abound in every good work (2 Corinthians 9:8). Share with Him your needs in relation to caring for your parents, trusting Him to fully equip you for this good work to which He has called you.
Dear Heavenly Father, parents are a precious gift from You. Thank you for allowing me the joy of having my parents for many decades, that I might enjoy them and learn from them. I pray that you would help them to continue growing in grace and in their relationship with You until the very end of their time here on earth. Please grant me wisdom and strength to care for them in a way that honors them, and honors You. It’s in the name of my Savior, Jesus Christ, that I pray. Amen.
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